Provider Demographics
NPI:1396255683
Name:ANEBO, KOJO (ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:KOJO
Middle Name:
Last Name:ANEBO
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:MR
Other - First Name:KOJO
Other - Middle Name:
Other - Last Name:ANEBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ADMINISTRATOR
Mailing Address - Street 1:1723 CARRIAGE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3675
Mailing Address - Country:US
Mailing Address - Phone:214-875-6961
Mailing Address - Fax:972-780-5579
Practice Address - Street 1:1723 CARRIAGE CREEK DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3675
Practice Address - Country:US
Practice Address - Phone:214-875-6961
Practice Address - Fax:972-780-5579
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel